MEDICAL EVALUATION FORM

 LOCALIZED PAIN PROGRAM

Dear Patient,

You may submit your personal health issue to our attention, using this appropriate data collection form.

Please attach any blood work or test results as well as any medical examination in your possession. You can attach them to the form or send later to: assistenza @ biomediccenter.com)

Our team will meet at no charge to evaluate your documentation, in order to understand if our center is effectively able to provide tangible assistance and if so, which professionals of our technical team, based on their specific skills, should be in charge of following you along this path.

Once this has been defined, our Information and Consultancy Manager will contact you to explain what our first meeting will consist of including all details, the duration of visits and costs.

If you then decide to schedule a first visit at our facility, our Reservations Manager can assist you in finding the best available appointment in our agenda.



















    If you have medical tests or checks related to your problems, please attach them or send them after submitting this form by e-mail to: [email protected]

    - Consent to informative communications (optional):

    The Medical Center periodically sends insights on specific aspects related to health, practical advice directly suggested by its professionals and updates on the services provided.

    You may withdraw your consent at any time.

    - Consent to the processing of data in compliance with art. 13 of the GDPR 679/2016 and the company Privacy Policy (necessary to be able to view and respond to your request)*:

    In compliance with the art. 13 of the GDPR 679/2016 and our corporate Privacy Policy, we inform you that by submitting this form you authorize Biomedic to process personal data contained in the form itself in the manner and terms of the information provided.

    I declare to have read and acknowledged the Privacy Policy (apri in nuova finestra).